The series was created by Cynthia Mort and originally conceived as Sexlife. The pilot episode was produced and directed by Patricia Rozema and shot in Winnipeg, Manitoba. The series was picked up by HBO for a second season in October 2007, but was ultimately canceled in July 2008 when Mort said she and the network "were unable to find the direction of the show for the second season".[1]

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Tell Me You Love Me revolves around three couples, Jamie and Hugo (Borth and Kirby), Katie and David (Walker and DeKay), and Carolyn and Palek (Walger and Scott), each with their own problems concerning intimacy in their relationships. They seek the help of therapist May Foster (Alexander), who herself has relationship problems with her partner Arthur (Selby).

Each episode screens without any introduction, no title cards, and no opening credits. The episodes are also shot with handheld cameras, giving the show a somewhat documentary-like feel. No episode has a music score or soundtrack, except for one song which generally starts in the last two to three scenes and carries over the closing credits. The title card for the show is not shown until immediately before the closing credits.

The series gained early publicity because of its extremely realistic depictions of sexual intercourse, oral sex and masturbation.[2][3][4][5] Despite persistent rumors to the contrary, and a notable lack of comment on the matter from either HBO or the production team, the sex scenes were finally simulated. Director Patricia Rozema was among those to have addressed this issue directly:

But it's not real, it's simulated. At one point, one of the producers was floating this idea in the trade papers that it would be real sex in the series. I immediately said, "Well, find another director, I don't want to do that." I wasn't interested in that.[6]

With regard to these controversial scenes actress Jane Alexander has said the following:

You know, people tend to believe those scenes, when they see them, are real, but they're not. They're acted. Our union doesn't even let us have any real sex, not that we would anyway. But just acting with someone like David [Selby], whom I have known for so long, it was fine. Those scenes are never easy.[7]

Michelle Borth, whose scenes were the most explicit, said, "We tried to do it as authentic as possible, but we were not having sex."

The first episode of the show only attracted a total of about 910,000 viewers—far fewer than what the network had been pulling in for previous series such as Rome, Deadwood, and even the ill-fated John from Cincinnati.[9] A month after its debut, HBO claimed the show had drawn a total of 3.1 million viewers across seven broadcasts.[10]